Epidemiologic trends, diagnostic limitations, and public health challenges of enteric fever in sub-Saharan Africa: A narrative review

Objectives This paper reviews existing literature on the prevalence and epidemiologic trends of enteric fever in sub-Saharan Africa. It also evaluates diagnostic limitations and explores the region’s public health challenges related to disease control. Methods A comprehensive search across six major databases initially identified 1831 articles. Of these, 40 peer-reviewed articles published between 2000 and 2024 met the inclusion criteria. Data were extracted on country, sample size, diagnostics, and prevalence. Risk of bias was assessed using the Newcastle–Ottawa Scale, whereas the Joanna Briggs Institute checklist was used for quality assessment. Results Among the 40 included studies, the highest prevalence of enteric fever was observed in children under 15 years of age (65%). Despite its well-known limitations as a diagnostic test, the Widal test was used in approximately 75% of studies. Only 30% of patients received blood cultures, and fewer than 10% received advanced diagnostics such as polymerase chain reaction or Typhidot. Multidrug-resistant Salmonella Typhi strains were reported in 60% of the studies. Conclusion Enteric fever remains a significant public health issue in sub-Saharan Africa, particularly affecting children and vulnerable groups. Barriers, including inadequate diagnostics, fragile health care systems, and low vaccine coverage, hinder efforts to control the disease.